It's up to patients to help fight health care fraud and abuse - GUEST OPINION

By ROBERT BICKMEYER

Monday, March 18, 2013

Patients and consumers can do much to cut health care costs, but there are greater minds than mine with even better ideas. In a recent column in The Oakland Press, Charles Krauthammer suggested tort reform, whereby frivolous lawsuits cannot enrich greedy patients and their already rich malpractice lawyers, reduction of unnecessary tests, procedures and referrals undertaken solely to fend off lawsuits. As Krauthammer wrote, "The United States has the best health care in the world, but because of its inefficiencies, also the most expensive."

We must cut costs.

Many approaches have been suggested to tackle this enormous problem, without mention of the multitude of abuses by some doctors, dentists, hospitals, drug companies and patients.

Some years ago my periodontist performed gum surgery on me. He unethically and fraudulently billed my insurer for work not authorized by me, plus work not performed, whereby he was paid $990 against my $1,000 benefit year maximum, but I checked my explanation of benefits form. As a result of my letters and phone calls he refunded $630 to my insurer.

A few years later, I visited my urologist for a simple biopsy of the prostate. Instead, I was put on an assembly line of specialists and given a barrage of five tests for which he was paid $1,532.50. I had naively allowed my insurer and myself to be financially abused.

I once visited an internist, telling him, "My cholesterol is 290. I'd like medication to lower it." He readily gave me the prescription I asked for, but his assembly line took blood, urine and gave me an EKG. He then tried to schedule me for a stress test, sigmoidoscopy and rectal smear. He was angered when I declined all those unnecessary tests, designed to bring extra dollars into his office.

I "fired" a podiatrist, in writing, for submitting a fictitious expense to Medicare.

I called a dentist to question a charge on my explanation of benefits form. His clerical assistant returned my call, advising that their claim was an error and a refund would be made to my insurer.

My wife's physician recommended her to a specialist for a problem with her hand. He took one look at it and told her, "There is nothing I can do. I suggest you see Dr. 'Smith.' Then he billed our insurer for "medical care." When I questioned his claim that he had provided medical care, he agreed it was a staff error and returned my check and refunded the amount to my insurer.

My dentist recently referred me to a periodontist for a simple, specific procedure, but the periodontist decided I required scaling and root planing of all gums, about four hours of work. When I questioned the need, he reduced the absolute need to two and one-half hours of treatment. He was paid $576 for such treatment, $230 per hour. Further, the work was performed by a hygienist, not the periodontist. As a result of these exorbitant fees, I canceled my next appointment and advised him that I will henceforth use dentists in my Preferred Dentist Program.

After a 3 a.m. emergency appendectomy, my surgeon advised me, "I think you will be able to go home Tuesday." My concerned wife, who has the instincts of a nurse, interjected, "Isn't that too soon? Shouldn't he stay another day?" The surgeon agreed. Hindsight now tells me that if I had to pay hospital charges for the extra day I would have gone home Tuesday.

A thoroughly well-planned education of patients and consumers to watch, ask questions and intimidate those fraudulent, greedy practitioners will lower health costs. A severe crackdown on fraud and abuse, both rampant, will cut costs of the best, most expensive health care in the world and must be included in any health care reform.

I believe doctors deserve healthy fees after their lengthy, expensive training. Too often, though, patients look upon them as godlike, putting them on a pedestal. I remind those patients of that statistical fact that 50 percent of all doctors graduated in the lower half of their class.